This case provides an approach to the management of protracted second phase of labor in a term primigravida by operative vaginal delivery (OVD). Forceps and vacuum are useful tools to expedite a vaginal delivery when indications are present and prerequisites are met. Risks and potential complications include maternal trauma (such as obstetric anal sphincter injury) and neonatal injury, which occurs in <1% of OVD. While an integral part of obstetric care, use of forceps and vacuum, has decreased to <3% of deliveries, with vacuum used more frequently than forceps. Knowledge of instruments and technique are essential to successful OVD. Both forceps and vacuum are safe and effective means to expedite delivery compared to cesarean section, in the proper setting.

The third volume of Tristram Shandy opens with Tristram’s eventual arrival into the Shandy family, when his nose is crushed during a bungled forceps delivery, causing Walter to throw himself prostrate on the bed. Sterne inserts his most startling innovation, the marbled page, within a volume almost entirely concerned with the publication and collection of medical books. This chapter situates Sterne’s remarkable visual device within a history of colour book illustration dominated by scientific works of the kind treasured by Walter Shandy. It also recounts the history of marbled paper, commonly recognised as book binding material but lesser known as medical packaging for nostrums prescribed to treat wounds and ailments. As a colour illustration in the instalment of Tristram Shandy addressing a wounded nose, for eighteenth-century readers the colour and dimensions of the marbled leaf would have simultaneously recalled colour-illustrated medical books and distinctively packaged branded remedies. The marbled page, therefore, references a full range of paper materials seeking to theorise, diagnose and treat malfunctioning bodies.